RESULTS: Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).
CONCLUSIONS: In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.
结果:射血分数(HFrEF)降低且先前植入起搏器(PM)或植入式心脏复律除颤器(ICD)且右心室(RV)起搏负荷≥20%的心力衰竭患者被随机分配接受CRT和除颤器(CRT-D)升级(n=215)或ICD(n=145)。原发性[HF住院(HFH),全因死亡率,或左心室收缩末期容积减少<15%]和次要结局进行调查.在入学时,131例(36%)患者有房颤,与SR患者相比,HFH风险增加[校正风险比(aHR)2.99;95%置信区间(CI)1.26-7.13;P=0.013].在平均随访时间12.4个月期间,房颤患者的CRT-D升级效果与SR患者相似[房颤调整比值比(aOR)0.06;95%CI0.02-0.17;P<0.001;SRaOR0.13;95%CI0.07-0.27;P<0.001;交互作用P=0.29]。此外,它降低了HFH或全因死亡率的风险(aHR0.33;95%CI0.16-0.70;P=0.003;交互作用P=0.17),并改善了超声心动图反应(左心室舒张末期容积差-49.21mL;95%CI-69.10~-29.32;P<0.001;交互作用P=0.21).
结论:在具有高RV起搏负荷的房颤和PM/ICD的HFrEF患者中,与ICD相比,CRT-D升级降低了HFH的风险并改善了反向重塑,与SR患者相似。